Forms

Patient Forms

Below is a list of downloadable PDF forms. Feel free to fill out any of the forms before your appointment.

Child Patient Health Information Authorization Form

Meet The Doctor Interview Form

Motor Vehicle Accident Form

Motor Vehicle No-Fault Law Form

Newborn Information Form

New Patient Form

Patient Update Form

Prenatal Interview Form

Ages & Stages Questionnaire for 2 ½ year well visit

PHQ-2 and 9

SCARED Parent Form

SCARED Child Form

Telemedicine Forms

Please complete the forms electronically and email them to telemed@fairportpediatrics.com

ADHD Rating Scale Adult

CES D Kids

Edinburgh Postnatal Depression Scale

GAD7 Questionairre

M-CHAT

PHQ-9 Modified Teens

PHQ-9 Adult

Vanderbuilt Parent Rating Scale

SCHOOL/SPORT/CAMP FORMS

New York State mandates physical examinations for students entering the following grades:

Kindergarten

2nd grade

4th grade

7th grade

10th grade

first year of college

Sports, summer camps, and other activities usually require annual physicals. We will complete a physical form for you at the time of your child’s annual physical exam and ask that you keep a copy for your future needs.
A look at one of our exam rooms

Have a Question? Feel free to contact us.

Phone: (585) 223-6111
Fax: (585) 223-0878

Contact Us

New to the area & looking for a pediatrician?

We know parents like to meet the pediatrician before committing to an office and we are happy to schedule a meet-the-doctor appointment so you have that opportunity and the ability to briefly discuss any concerns you may have.

Call us (585) 223-6111
Fairport Pediatrics, LLP

460 CrossKeys Office Park
Fairport, NY 14450

Fairport Pediatrics Address

Fairport Pediatrics, LLP
460 CrossKeys Office Park
Fairport, NY 14450-3590

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Connect With Us

Phone: (585) 223-6111
Fax: (585) 223-0878

Office Hours

Monday - Friday: 8 am - 4:30 pm
Saturday: 8 am - 11:30 am
Extended hours Sunday: 9:30am – 11:30am

Proudly serving patients from Monroe, Wayne and Ontario Counties.